Objective/Hypothesis: The dart throwers’ motion and its influence on restricting movement at the scapholunate joint have been well discussed over the past 12 years. Its potential for use in rehabilitation of persons with scapholunate interosseous ligament tears has been encouraged; however, evidence of its value to conservative management of this injury remains limited. There is also limited evidence that dart throwers’ orthoses (DTO) actually restrict movement to the plane they are designed to restrict it to. The authors will report on the ability of 1 particular type of DTO to control motion to the dart throwers’ plane and then will discuss the results of the integration of this same DTO into a neuromuscular rehabilitative program for conservative management of scapholunate injury. Materials and Methods: We present an orthosis that restricts motion to the dart throwers’ motion plane and discuss its role as part of a hand therapy program. A video fluoroscopy study was completed to assess the orthosis’s restrictive influence on scapholunate motion within the dart throwers’ plane of radial extension to ulnar flexion. The fluoroscopy was completed on a patient with a deficient scapholunate ligament in one wrist, and an intact scapholunate ligament in the other. The orthosis had previously been fitted to a series of 5 patients over a period of 6 years. All patients had a demonstrated scapholunate interosseous ligament injury. Follow-up was from 7 months to 5 years with a median value of 4 years. After a prescribed period of DTO use, the patients began a neuromuscular rehabilitation program designed to enhance the proprioceptive capacities of the joint and to reinforce the role of secondary stabilizers in the wrist. Results: Video fluoroscopy testing indicated that the DTO used was able to restrict scapholunate motion in both scapholunate interosseous ligament (SLIL) intact and deficient wrists as it moved through the dart throwers’ plane. All patients returned to their preinjury level of activity and all reported improved functional hand use in subjective testing following intervention. Visual analogue pain scores were reduced from a mean of 6.5 pre treatment to 0 at the end of treatment. Grip strength and range of motion had returned to be within normal limits in all patients post treatment. Conclusions: The use of video fluoroscopy with an innovative orthosis demonstrated the ability of the orthosis to restrict scapholunate motion following damage to the scapholunate interosseous ligament. Promising results that followed the use of this DTO in combination with a neuromuscular re-education program indicate potential for these guidelines in the conservative management of this injury.
